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. 2025 Aug 7;15(1):105.
doi: 10.1007/s44197-025-00449-z.

Indications for Pediatric Enucleations of Non-Retinoblastoma Globes in Saudi Arabia with Clinical and Radiological Correlation To Final Histopathological Diagnosis

Azza My Maktabi  1 , Hala A Helmi  2   3 , Yaser M Benthabet  4 , Seham Aljohar  5 , Hind Manaa Alkatan  6   7   8
Affiliations

Indications for Pediatric Enucleations of Non-Retinoblastoma Globes in Saudi Arabia with Clinical and Radiological Correlation To Final Histopathological Diagnosis

Azza My Maktabi et al. J Epidemiol Glob Health. .

Abstract

Background: Enucleation is a difficult surgical decision in the ophthalmic practice. The overall commonest indications for this procedure are intraocular neoplasm (mostly retinoblastoma in children and uveal melanoma in adults), trauma, painful blind eyes, phthisis bulbi, and microphthalmos for cosmetic restoration of the orbital size. Specific indications vary according to age groups, gender, and geographical areas. In this study we aim to investigate the indications -other than retinoblastoma- for enucleation in the pediatric age group to observe the trends and significant associations of these indications with our demographic and social background.

Methods: A retrospective cohort study of non-retinoblastoma globes based on histopathological examination obtained from pediatric patients younger than 18 years of age in a tertiary eye hospital over the period 2000 to 2021. Descriptive analysis was used as well as comparative analysis to highlight the differences between clinical, radiological, and final histopathological diagnoses and to correlate different ophthalmic indications to age and gender. We also investigated the accuracy of clinical and radiological evaluation with special attention to the misdiagnosis of retinoblastoma.

Results: A total of 47 enucleated globes from 47 patients were included in the study with the majority being in the younger age group of three years or less (40.4%). Males constituted 57.4% of the cohort and the remaining 42.6% were females. Ruptured globe was the main clinical indication in about half of the enucleations followed by painful blind or phthisical eyes. Traumatic enucleations were significantly associated with older age group of 7 years or older (p = < 0.001). Interestingly, four globes and three globes were mis-diagnosed as retinoblastoma clinically and radiologically respectively and were accurately diagnosed after histopathological examination of the enucleated globes.

Conclusion: Eye trauma is a leading cause for pediatric enucleation in about half of the non-retinoblastoma globes with higher prevalence in older children. When combined with end stage traumatized globes presenting as painful blind eye or phthisis bulbi, the rate increases to 57.4% of the enucleations. Health awareness and safety measures during sports and other activities should be implemented. Ophthalmologists should be aware of ophthalmic diseases presenting as pseudoretinoblastoma leading to possible unnecessary enucleations.

Keywords: Children; Coats; Enucleation; Masquerade; Retinoblastoma; Ruptured globe; Trauma.

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Conflict of interest statement

Declarations. Ethics Approval and Consent to Participate: This study was prepared in accordance with the ethical standards of the Thesis Committee and Human Ethics Committee/Institutional Review Board (HEC/IRB) at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia as a retrospective study (Research Project No. E-22093-R) in accordance with the Helsinki Declaration. A general informed written consent was taken from the patients and/or guardians of all cases which includes permission as part of the common practice for anonymous use of data for the purpose of publication. Consent for Publication: A general informed written consent was taken from all the participants involved in this study, which includes permission for anonymous use of data for the purpose of publication. Competing Interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of 47 patients according to the main presenting complaint:
Fig. 2
Fig. 2
Indications for enucleation according to the clinical diagnosis (n = 47): “Other” included endophthalmitis in 2 globes and neurofibromatosis in 1
See this image and copyright information in PMC

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